Modern Pediatrics. Ukraine

Results of a study of the effectiveness of the use of a drug containing β-glucan in children with recurrent respiratory infections

O.Ye. Abaturov — 2025-06-15

Recurrent respiratory infections (RRI) in children are the most common cause of visits to paediatricians.

Aim - to evaluate the clinical and immunological efficacy of a 12-week course of a drug containing β-glucan, vitamins and zinc in preschool children with RRI.

Materials and methods. The study involved 120 children aged 5 to 7 years who attended preschool and/or primary school and had a history of at least 4 recorded cases of acute respiratory infections (ARI) in the last 6 months. The main group consisted of children with ARI (n=60) who received a drug containing β-glucan, vitamins and zinc (commercial name: Bewell) for 12 weeks of observation, and the control group consisted of 60 people with ARI who received basic preventive therapy. To determine the effectiveness of the drug containing β-glucan, vitamins and zinc, the level of mRNA expression of transcription factors (TBET, RORyt, FOXP3) of T-cells and NF-kB₁, interleukins (IL-1β, IL-17A, IL-10) and cytokine TGF-β₁ was determined by reverse transcription polymerase chain reaction.

Results. The use of a complex drug containing β-glucan, vitamins and zinc in children with ARI helps to reduce the risk of recurrent ARI, reduces the duration of subsequent ARI, and prevents the use of antibiotics and antipyretic agents. RRI are characterised by increased expression of the genes of the transcription factor TBET, NF-kB₁, and interleukins IL-1β, IL-17A in the buccal mucosa. In children, after treatment with a preparation containing β-glucan, vitamins and zinc, there was a decrease in the expression of the transcription factor NF-kB₁, transcription factors of proinflammatory immune cells, in particular Th₁- and Th₁₇-cells, proinflammatory interleukins; and an increase in the activity of both the transcription factor Treg-cells and anti-inflammatory IL-10, TGF-β₁.

Conclusions. The prevention course with a preparation containing β-glucan, vitamins and zinc inhibits the pro-inflammatory activity of the immune system and promotes the expression of the transcription factor FOXP3 and anti-inflammatory cytokines IL-10, TGF-β₁.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Delayed and incomplete immunization of children: cross-sectional community-based survey study among population of Kyiv, Rivne, and Volyn regions of Ukraine

Ye.O. Grechukha — 2025-06-15

Immunization is essential for preventing infectious diseases, yet timely vaccination remains a challenge globally, particularly in regions affected by war and disrupted healthcare infrastructure. Ukraine faces unique challenges, including systemic issues and vaccine hesitancy, impacting immunization timeliness.

Aim - to determine the rate and characteristics of delayed immunization and its completeness among children in three regions of Ukraine.

Material and methods. A cross-sectional, community-based survey was conducted at state and private primary healthcare facilities in Kyiv, Bucha, Rivne, and Lutsk. Data were collected via structured questionnaires, face-to-face parental interviews, and medical documentation review. Statistical analyses included descriptive statistics, chi-square tests, logistic regression, and Kaplan-Meier analysis.

Results. Out of 152 children, 64.3% were fully vaccinated, but only 50% received timely vaccinations. The significant reasons for delays included untimely healthcare visits (29.2%), vaccine hesitancy (25.8%), and acute illness (18%). The presenсe of comorbidities in children was a statistically significant risk factor for delayed immunization. Kaplan-Meier analysis illustrated notable delays, especially for older children.

Conclusion. This study identifies critical barriers to timely immunization, emphasizing the need for improved healthcare accessibility, targeted educational initiatives, and enhanced professional training. Further research is required to develop comprehensive interventions, particularly considering Ukraine's complex demographic challenges due to internal displacement of the population.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee for all participants. The informed consent was obtained from patients.

The authors declare no conflict of interest.

Rational treatment of acute rhinosinusitis in children

S.A. Levytska — 2025-06-15

Acute rhinosinusitis is among the most common respiratory conditions in children, particularly during periods of active socialization and immunological immaturity. Despite its predominantly viral etiology, antibiotics are frequently prescribed inappropriately, emphasizing the need for safe and effective pathogenetic treatment strategies.

Aim - to assess the clinical efficacy and tolerability of the complex homeopathic medicinal product Cinnabsin in the treatment of acute viral rhinosinusitis in children, compared to standard symptomatic therapy.

Materials and methods. A total of 65 children aged 5-15 years with signs of acute upper respiratory tract infection were enrolled in this observational study. The treatment group (n=36) received Cinnabsin along with nasal saline irrigation, while the control group (n=29) was treated with nasal saline irrigation, decongestants, and mucoactive agents. Clinical symptoms were evaluated on days 3 and 7 using a 5-point Visual Analogue Scale (VAS), an objective symptom severity score, and odds ratios (OR) to quantify treatment effects. Treatment tolerability was assessed based on parental and physician ratings.

Results. By day 3, the treatment group showed a more pronounced reduction in key nasal symptoms, particularly nasal obstruction and rhinorrhea. On day 7, significant improvement was observed in the treatment group (p<0.05), with ORs ranging from 2.38 to 5.86 in favour of the treatment group. Tolerability was rated as "Very good" in 94.4% of cases, and no adverse effects associated with Cinnabsin were reported.

Conclusions. Cinnabsin demonstrated high clinical efficacy and excellent tolerability in the management of acute viral rhinosinusitis in children, particularly in alleviating nasal symptoms. These findings support its use as a rational pathogenetic therapy in pediatric clinical practice.

The author declares no conflict of interest.

Morphological features of subcutaneous tissue of the antebrachial region in human fetus

T.V. Pankiv — 2025-06-15

Aim - to clarify the morphological features of the structure and topography of adipose tissue in the forearm region of human fetuses at 5-8 months of gestation in order to clarify normal developmental parameters and identify possible variants or abnormalities.

Material and methods. A microscopic study was performed on the material of the antebrachial region of 21 human fetuses measuring 136.0-310.0 mm parietal-coccygeal length (PCL), with subsequent statistical data processing.

Results. In the studied 5-month-old human fetuses, no objects that could be identified as adipocytes were found in the upper, middle, and lower thirds of the antebrachial region. The absence of fatty formations was also observed at the level of the lower third of the forearm in 6-month-old fetuses. In the upper third of the antebrachial region of 6-month-old fetuses, the percentage of multilocular adipocytes is 91.8±0.87%, at the level of the middle third - 72.3±0.85%. In 7-month-old fetuses, multilocular adipocytes in the upper third of the antebrachial region account for 47.8±0.84%, in the middle third - 49.0±0.83%, and in the lower third of the antebrachial region - 61.9±0.86%. In the upper third of the antebrachial region of 8-month-old fetuses, multilocular adipocytes are 39.0±0.85%, in the middle third - 24.4±0.84%, and in the lower third of the antebrachial region - 34.6±0.84%.

Conclusions. The adipose tissue of the forearm area is represented by uni- and multilocular cells. In 6-month-old fetuses at the level of the upper and middle thirds of the antebrachial region, as well as in 7-month-old fetuses at the level of the lower third of the antebrachial region, multilocular cells quantitatively prevailed, at the level of the upper and middle thirds of the antebrachial region of 7-month-old fetuses and in all thirds of the antebrachial region of 8-month-old fetuses - unilocular cells. The largest number of adipocytes was found in 8-month-old fetuses. Between 6 and 7 months of gestation, a leap in the development of adipose tissue is noted.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee for all participants.

The authors declare no conflict of interest.

The value of haematological indices of intoxication in sepsis associated respiratory distress of newborns

O.K. Teslitskyi — 2025-06-15

Neonatal sepsis remains a significant problem in neonatal practice. However, there is a paucity of research on the prevalence, incidence, diagnosis and outcome of acute respiratory distress in a cohort of newborns with sepsis.

Aim - to evaluate changes in integral haematological indices of inflammatory syndrome activity in newborns with sepsis-associated respiratory distress in the dynamics of the disease and determine their prognostic significance.

Materials and methods. To achieve the set goal, a comprehensive examination of 87 newborns diagnosed with neonatal sepsis. Depending on the presence of respiratory distress symptoms, newborns with neonatal sepsis were divided into two clinical groups. The group I consisted of 22 infants in whom the respiratory component was assessed at ≥2 points on the nSOFA scale, and the group II consisted of 65 newborns with a score of “0” points.

Results. Based on a comprehensive paraclinical examination and analysis of the mean group values of the integral hematological indices of inflammatory syndrome activity, no statistically significant differences were found between newborns depending on the presence or absence of respiratory disorders. However, an increase in the leukocyte intoxication index distribution point to 2.0 conventional units allowed us to establish that this level was observed in 36.4% of newborns in the group I and in 29.2% of representatives of the group II upon admission. In the dynamics after 72 hours, the frequency of registration of this indicator was 36.4% and 10.8%, respectively, which confirmed a more severe course of an inflammatory process in newborns of the group I that was insufficiently sensitive to treatment.

Conclusions. The statistically significant risk of sepsis-associated respiratory distress correlates with the severity of the infectious process, namely: at a level of leukocyte intoxication index ≥2.0 conventional units in the dynamics of treatment, there is a 4.73-fold increase in the chances of this event occurring, with a specificity of this available marker of 89.2%.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the paper. The study was conducted with the informed consent of the children's parents.

The author declares no conflict of interest.

Sleep disorders in children with recurrent acute respiratory diseases and background lymphadenoid hypertrophy

O.B. Synoverska — 2025-06-15

Episodes of acute respiratory diseases are the most common cause of sleep disturbance in young children. Lymphadenoid hypertrophy (LAH) plays an important role in the formation of recurrent respiratory pathology, which creates a mechanical obstacle to airflow and leads to the development of obstructive sleep apnea syndrome (OSAS). Obstruction, hypoxia cause numerous awakenings and contribute to significant metabolic, cardiovascular and neurocognitive disorders.

Aim - to study the features of clinical and somnographic sleep disorders in children with recurrent acute respiratory diseases (RARD) and to establish their dependence on the presence of background lymphadenoid hypertrophy.

Materials and methods. 30 children with recurrent acute respiratory diseases (RARD) without manifestations of LAH, 30 children with RARD on the background of LAH and 20 somatically healthy children were examined. The average age of the children was (6.4±0.6) years, which was comparable between the groups. A questionnaire was conducted with parents regarding sleep disorders in children.

Results. Analysis of questionnaires showed that children with background LAH had pronounced nocturnal symptoms of pharyngeal obstruction such as snoring, pauses in breathing, difficulty breathing, frequent awakenings. The consequence of nocturnal sleep disorders were daytime symptoms (sleepiness, psychoemotional problems). In general, such disorders were detected in 26.6% of children with RARD and 76.6% of children with concomitant LAH. At the second stage, all children with sleep disorders underwent polysomnography, which established the development of nocturnal apnea and hypoventilation syndrome during sleep, while the apnea-hypopnea index was (9.2±2.6) episodes/h in children with LAH versus (2.2±0.6) in children without LAH.

Conclusions. Children with RARD and background lymphadenoid hypertrophy have a significant risk of developing obstructive sleep apnea syndrome. For screening diagnostics of this syndrome, it is advisable to use questionnaires that allow to identify night and day symptoms of upper airway obstruction. The presence of apnea and hypopnea and, as a result, the development of hypoxemia generates a considerable number of clinical symptoms and syndromes and worsens the quality of life of children and their families in general.

The study was performed in accordance with the principles of the Declaration of Helsinki. Informed consent of the child's parents was obtained for the study.

The authors declare that there is no conflict of interest.

Fetal anatomy of the fascial-cellular spaces of the lateral face region

R.M. Soltys — 2025-06-15

In order to comprehend the etiopathogenesis of surgical pathology and traumatic injuries of the maxillofacial region and possible ways of inflammatory processes spreading, thorough knowledge of the age-related variant anatomy of the fascial-cellular formations of the facial region of the head is of particular importance.

Аim - to clarify the peculiarities of morphogenesis and formation of the topography of fascial-cellular spaces of the lateral face region in human fetuses, taking into account the forms of their anatomical variability, in order to develop new methods of diagnosis, prognosis and treatment of congenital and acquired pathology of organs and structures of the maxillofacial region..

Materials and methods. The study was conducted on head preparations of 38 human fetuses with a parieto-coccygeal length of 81.0-375.0 mm using macromicroscopic preparation, vascular injection, and morphometry.

Results. Starting from 6 months of fetal development, subcutaneous adipose tissue, especially in the buccal, parotid-masticatory and deep lateral areas of the face, is relatively well expressed. Different density of the parotid fascia has been observed, in particular, its thinning or absence in the areas of the superior surface of the gland and the internal surface of the pharyngeal process. This suggests that the fiber surrounding the parotid gland may have a connection with the fiber of the peripharyngeal space. The fascia on the external surface of the parotid gland was found to be loose. In fetuses of 9-10 months, in the area between the maxilla and the anterior edge of the ramus of the mandible, the buccal fat pad tightly adheres to the tissue of the upper part of the pterygo-maxillary space, as well as to the tissue of the pterygo-palatine fossa. Therefore, at the stages of postnatal human ontogenesis, this may contribute to the spread of purulent-inflammatory processes from the buccal fat pad into the temporal and infratemporal fossae, pterygo-maxillary space, etc. The lateral pterygoid muscle and loose tissue are located in the posterior part of the infratemporal fossa, which in fetuses of 8-10 months form single clusters - on the external surface of the muscle - the temporal-pterygoid fissure; on the internal surface of the muscle - the extrapterygoid space; on the superior surface of the lateral pterygoid muscle - the epipterygoid bone-fascial space. These structures appear as narrow slits. In human fetuses, the pterygoid venous plexus, which is located on the external surface of the lateral pterygoid muscle, topographically corresponds to the temporal-pterygoid cellular space.

Conclusions. In human fetuses, a connection between the shape of the infratemporal fossa and the length of the fascial-cellular spaces of the deep facial region was found. Considering that the loose tissue of the infraorbital region is connected to the tissue of the buccal region, it can be assumed that abscesses that arise in the postnatal period can be located not only in the canine fossa region, but also extend superiorly and medially.

The study was conducted in accordance with international and national bioethical standards, which was confirmed by the conclusion of the Biomedical Ethics Commission of the Bukovinian State Medical University.

The authors declare no conflict of interest.

Novel mutations in the PIEZO1 gene in hereditary stomatocytosis: a severe case of anaemia and hepatosplenomegaly

O.I. Dorosh — 2025-06-15

Dehydrating hereditary stomatocytosis (DHS) is a rare hereditary haemolytic anaemia inherited in an autosomal dominant pattern, characterised by macrocytosis, the presence of stomatocytes and erythrocyte dehydration. The disease is based on increased permeability of erythrocyte membranes due to certain genetic defects (missense mutations in the PIEZO1 and KCNN4 genes), which causes an imbalance in intracellular cation concentrations. The disease has variable clinical manifestations, which complicates its timely diagnosis.

Aim - to describe a clinical case of DHS1 caused by two novel variants in the PIEZO1 gene c.5590C>T (p.Arg 1864Cys) and c.76C>T (p.Arg26Cys) in a 5-year-old girl with transfusion-dependent anaemia, massive hepatosplenomegaly and psychophysical developmental delay.

Clinical case. The girl has been ill since birth. Increased abdominal size, hepatosplenomegaly and decreased blood counts were first noticed at the age of 7 months. Severe anaemia was controlled by haemotransfusions. The initial pathological bone marrows (ВМ) examination diagnosed reticulin myelofibrosis. Multidisciplinary genetic tests were performed. Carriers without clinical significance were found epidermolysis bullosa (COL7A1 gene) and nephronoptosis (NPHP1 gene). NGS (Next-Generation Sequencing), a panel of hereditary anaemias, identified mutations c.5590C>T (p.Arg 1864Cys) and c.76 C>T (p.Arg26Cys) in the PIEZO1 gene, in combination with clinical and laboratory changes was diagnosed DHS1.

Conclusions. DHS1 in children is a rare disease that can have a severe clinical course and cause significant diagnostic difficulties. The presence of two mutation variants in the PIEZO1 gene: c.5590C>T (p.Arg1864Cys) and c.76C>T (p.Arg26Cys) can aggravate the disease. Visual assessment of blood smear and NGS are important methods for the diagnosis of hereditary anaemias.

The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Vascular malformations in children: a rare case of vascular nevus and its clinical features

M.D. Protsailo — 2025-06-15

Vascular malformations in children encompass a diverse spectrum of congenital anomalies, often presenting at birth or in early childhood. Among these, vascular nevi (port-wine stains, or nevus flammeus) represent congenital capillary malformations that may lead to significant cosmetic and functional impairments.

Aim: to identify the main clinical and genetic features of a rare case of vascular nevus in a child and to determine the diagnostic criteria that allow timely differentiation of this pathology from other vascular malformations.

Clinical case. This study presents a retrospective analysis of a clinical case of vascular nevus in a 6-year-old girl. The patient exhibited congenital vascular pigmentation and progressive limb asymmetry. The patient presented with an extensive capillary malformation affecting the lumbar region, thigh, lower leg, and foot, associated with hypertrophy of the affected limb. X-ray examination confirmed a 2 cm anatomical lengthening of the right tibia with preserved growth plate function. Clinical features raised suspicion of phakomatosis, necessitating differential diagnosis with such conditions as Klippel-Trenaunay-Weber syndrome, Sturge-Weber syndrome, neurofibromatosis, and tuberous sclerosis. Genetic testing did not reveal pathogenic mutations commonly associated with phakomatoses, supporting the final diagnosis of an isolated vascular nevus with musculoskeletal involvement. The patient was prescribed a multidisciplinary treatment plan, including orthotic correction, physical therapy, and postural monitoring to prevent scoliosis progression.

Conclusions. Vascular malformations, particularly large vascular nevi, can induce disproportionate musculoskeletal growth, mimicking syndromic phakomatoses. The case highlights the necessity of integrating clinical, radiological, and genetic evaluations to ensure accurate diagnosis and tailored management. The findings emphasize the importance of long-term monitoring in children with complex vascular anomalies to optimize functional outcomes and prevent secondary orthopedic complications.

The study was carried out in accordance with the principles of the Declaration of Helsinki. The informed consent of the children's parents was obtained for the research.

No conflict of interests was declared by the authors.

Features of the clinical course of Nijmegen breakage syndrome in children. Clinical case

V.M. Dudnyk — 2025-06-15

Nijmegen breakage syndrome (NBS) is a rare disorder with autosomal recessive inheritance. It belongs to a group of disorders often called chromosomal instability syndromes. Clinically it is typically by facial dysmorphic changes at birth without neurological manifestations. Other important clinical features, more pronounced with age, include mild growth retardation, premature ovarian failure, a tendency to recurrent infections of various organs, and a very high risk of developing malignancies at an early age, most often of hematological origin. The disease is based on a combined immunodeficiency of both cellular and humoral responses.

Aim - to introduce practicing physicians with the features of the clinical manifestations and course of NBS in a child.

Clinical case. The features of the clinical course of NBS are described and presented. The main diagnostic value of complaints, anamnesis, dynamics of clinical manifestations, laboratory and instrumental research methods, genome sequencing to confirm NBS, bone marrow examination to confirm T-cell leukemia, karyotyping method, genome sequencing corresponding to the detected 657del5 mutation of the NBN gene in the homozygous state are highlighted.

Conclusions. Nijmegen breakage syndrome is a pathology that is inherited in an autosomal recessive manner and belongs to the group of chromosomal instability syndromes with gene rearrangements. The presence of combined immunodeficiency in children with NBS is the basis for an increased risk of malignant neoplasms.

The study was performed in accordance with the principles of the Declaration of Helsinki. Informed consent of the child's parents was obtained for the study. The authors declare that there is no conflict of interest.

Congenital spondyloepiphyseal dysplasia due to COL2A1 gene mutation

O.M. Mukvich — 2025-06-15

Skeletal dysplasia is a rare genetic pathology that is a consequence of disorders of osteo-, chondrogenesis and other changes in the development and growth of epiphyseal cartilage, epiphyses, metaphyses, diaphyses of long bones and vertebral bodies, which leads to dysfunction of peripheral joints and spine in children.

Aim - to familiarize with the features of the course, clinical manifestations and diagnosis of spondyloepiphyseal dysplasia (SED) with osteoarthritis and progressive osteoporosis in childhood.

A clinical case of own observation of a child of adolescent age with complaints of difficulty walking, rapid fatigue, limping, starting pain in the joints, back during the day, limitation of function of the knee, hip, shoulder, elbow, radiocarpal joints, cervical spine, contractures of the elbow, radiocarpal joints is presented. In the presence of typical signs of the SED phenotype (short stature, specific facial features, rapid fatigue, limping, starting pain in the joints, back during the day, limitation of function of the knee, hip, shoulder, elbow, radiocarpal joints, cervical spine, contractures of the elbow, radiocarpal joints), no extraskeletal manifestations were detected in the child. During molecular genetic testing, a heterozygous variant in the COL2A1 gene (p.611G>A (p.Gly204Asp)) was identified in the patient, which is associated with bone disease and is characterized by the development of generalized osteoarthritis and systemic osteoporosis.

Conclusions. Congenital spondyloepiphyseal dysplasia in childhood can occur under the guise of rheumatic diseases without obvious laboratory activity of the inflammatory process and early development of contractures, stiffness in the joints and progressive osteoporosis. Patients require a comprehensive examination using modern laboratory, instrumental and genetic examination methods and careful differential diagnosis and involvement of a multidisciplinary team of specialists for the management of such patients.

The study was performed in accordance with the principles of the Declaration of Helsinki. Informed consent of the child's parents was obtained for the study.

The authors declare that there is no conflict of interest.

Diagnostics and treatment of the structural forms of epilepsy combined with anomalies of brain development in early children age

V.O. Svystilnyk — 2025-06-15

It is known that structural epilepsy occurs frequently at children’s age. Moreover, structural epilepsies are formed in some cases because of the pathological influence of congenital brain anomalies.

Aim - using the clinical case to present the features of the starts of structural epilepsy based on congenital brain anomalies in early age children and approach treatment for them.

The presented clinical case in the article showed the first focal epileptic seizures appeared at the age of 3.5 years old in the patient with Arnold-Chiari syndrome. Valproic acid has been prescribed as the first medication. The combined therapy included lamotrigine and diacarb has been prescribed for the incomplete control treatment the epileptic seizures in the patient. The next examination we carried out in 14 patients early children age with structural epilepsy caused congenital brain anomalies. Frequent predominately focal epileptic seizures started during the first fourth years of life have been found in the patients. The prescribed combined anticonvulsant therapy was effective in the patients.

Conclusions. Congenital brain anomalies as a cause of structural epilepsy in form predominately of focal epileptic seizures appeared in early children age. The prescribed therapy of epilepsy depended on the forms of them and children’s age. The next use of genetic investigation is important for confirming a possible genetic anomaly.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee for all participants. Informed consent was obtained from parents of child.

No conflict of interest was declared by the authors.

The use of a combination of amino acids (arginine, betaine, and carnitine) and riboflavin in pediatric practice (review article)

T.Yu. Kravchenko — 2025-06-15

Aim - to analyze the literature data on the role of amino acids, in particular arginine, betaine and carnitine in pediatric practice.

Information was searched in the Web of Science, Scopus, PubMed Central, Google Scholar databases using the following keywords: amino acids, arginine, betaine, carnitine, riboflavin, children. Amino acids are involved in many metabolic processes, in particular in the production of hormones, neurotransmitters and enzymes, contribute to the synthesis of nucleotides, maintenance of redox balance, cell and organism function. According to the literature, they play a fundamental role in childhood in building tissues, supporting brain development, participating in the synthesis of neurotransmitters, which is important for cognitive development, attention, and memory, supporting the immune system and the body's ability to recover from stress, injuries, and physical exertion. In addition to their physiological functions, amino acids are also active therapeutic ingredients used in the prevention and treatment of various diseases, including those of the nervous, cardiovascular, digestive, immune and endocrine systems. Arginine can help improve blood flow to organs that are stressed during intoxication, such as the liver and kidneys, and stimulate metabolism and the elimination of toxins. Carnitine can help maintain the body's energy balance by promoting the use of fatty acids as an energy source, which helps the body recover after intoxication. Betaine can help improve detoxification, support liver function, and reduce toxic substances in the body. Riboflavin, due to its antioxidant properties, can reduce cell damage caused by free radicals that occur during intoxication.

Conclusions. The combination of the amino acids arginine, betaine, carnitine and the addition of riboflavin can be extremely useful in pediatrics, since each of these components has specific properties that can complement each other, providing comprehensive support for children's health.

The authors declare no conflict of interest.

The application of bifidobacteria strains in the practice of pediatricians and general practitioners of family medicine (literature review)

A.O. Pysariev — 2025-06-15

The human microbiome includes trillions of bacteria, many of them play essential roles in their owner's physiology.

Аim - to systematize data on the effective use of bifidobacteria for various conditions in pediatric patients.

The article discusses the mechanisms of formation of the natural intestinal microbiome from birth, which consists mainly of strains of bacteria that produce lactic acid and short-chain fatty acids. Mechanisms of the influence of microbiota on biological processes in the body are presented for attention. The article reviews modern probiotics - drugs that, according to the definition of the World Food Organization and the World Health Organization, contain live beneficial microorganisms that occur naturally in the intestines, remain viable throughout the gastrointestinal tract, and effectively maintain the balance of the intestinal microbiome when administered in sufficient quantities. The basis of probiotics is made up of homofermentative Lactobacteria, which produce only lactic acid, and heterofermentative Bifidobacteria, which belong to the class Actinobacteria (gram-positive bacteria), order Bifidobacteriales and family Bifidobacteriaceae, and which produce both lactic and acetic acid. Given their large numbers in the intestine, especially in young children, their symbiotic relationship with humans, and their contribution to the breakdown of breast milk oligosaccharides, the article reviews the pharmacological aspects of the use of bifidobacteria, which are considered ideal probiotics for infants.

Conclusions. A unique complex with two strains of Bifidobacterium breve and innovative protection technology is the optimal choice for maintaining intestinal health in infants, preventing colic, improving digestion in the first months of life and during the introduction of complementary foods, as well as for restoring intestinal function in various pathological conditions.

The author declare no conflict of interest.

Modern approaches to diagnosis and treatment of respiratory epithelial dysfunction

T.R. Umanets — 2025-06-15

The integrity of the respiratory epithelium protects the airways from the penetration of external harmful agents. Impairments in the structure and function of the epithelial barrier can lead to chronic inflammatory processes that underlie the pathogenesis of numerous allergic and inflammatory respiratory diseases, particularly in children.

Аim - to review contemporary scientific literature on the role of epithelial barrier dysfunction in the development of allergic diseases, and to examine methods for the diagnosis and treatment of respiratory epithelial dysfunction (RED) based on the latest scientific evidence.

An analysis of literature from international databases, including PubMed, ScienceDirect, and Google Scholar, for the period 2018-2025 was conducted. RED involves the disruption of its structural integrity, leading to a compromised barrier function and increased permeability to external agents such as allergens, pollutants, and pathogens. In patients with asthma, a decreased expression of proteins that form tight junctions between epithelial cells is observed, constituting a critical pathogenetic mechanism in the development of respiratory allergic diseases. The combined use of modern methods—such as histological and immunohistochemical analyses, electron microscopy, mass spectrometry, proteomics, and the study of alarmins — allows for a more effective assessment of the respiratory epithelial barrier's status. Modern therapeutic strategies for RED are aimed at restoring the structure and function of epithelial tight junctions.

Conclusions. RED is a key factor in the development of asthma and other respiratory diseases, especially in the pediatric population. Early diagnosis and timely intervention to enhance epithelial barrier function are critical for achieving successful disease control. Future research prospects include the development of novel preventive and therapeutic approaches aimed at restoring and maintaining the integrity of the respiratory epithelium.

The authors declare no conflict of interest.

Congenital and acquired coronary artery disease in children: the challenging patients in paediatric practise

V.M. Dudnyk — 2025-06-15

Coronary artery disease (CAD) is a rare condition seen in the paediatric population, which makes it difficult to diagnose and manage these patients due to the broad spectrum of its clinical forms that ranges from asymptomatic course to the development of sudden cardiac death syndrome as a result of myocardial ischemia in children. CAD presents as acquired and congenital variants with varying subtypes.

Aim - to focus on aetiology, main clinical features, and early detection methods for CAD, prioritising children and adolescents to make it easier for the paediatric specialists to manage this challenging disease and prevent death.

For this review, a total of 50 articles have been analyzed from PubMed, Uptodate, Researchgate, Google Scholar, etc, which are taken from the past ten years of journals. Congenital CAD presents as defects of origin, course, or termination, and anomalous origin of the left coronary artery from the pulmonary artery, also known as ALCAPA, has the highest prevalence, and it causes 90% deaths within the first year of life. When it comes to acquired CAD, the common aetiology is found to be Kawasaki disease, which is a type of medium vessel vasculitis predominant in children between 6 months and 8 years. Another in line is familial hypercholesterolemia. It is observed that patients aged from 11-23 years, who have a history of familial hypercholesterolemia, 25% children and adolescents were found to have atherosclerotic plaques in the vessels that lead to myocardial ischemia and dysfunction. Accurate diagnosis requires specialized knowledge and skills using cardiac imaging methods. The “gold standard” method in this era is coronary computed tomography angiography, but it is not a routine test; therefore, doctors should educate themselves continuously with the latest updates in order to be able to determine the high-risk groups.

Improved knowledge about coronary artery pathologies can be of great help in diagnosing and managing children and help to prevent life-threatening complications or sudden cardiac death.

The authors declare no conflict of interest.

Surgical correction of aortic coarctation: what’s next? Long-term patient follow-up

A.A. Malska — 2025-06-15

Coarctation of the Aorta (CoA) is a congenital heart defect (CHD) characterized by a narrowing of the thoracic aorta at the level of the isthmus, typically near the insertion of the ductus arteriosus. CoA is among the most common congenital heart defects, with an incidence of 3-4 cases per 10,000 live births, accounting for 8-10% of all CHDs. Clinical manifestations depend on the degree of narrowing, the length of the affected aortic segment, and the timing of ductus arteriosus closure. CoA may present in the neonatal period or later in life. In neonates, the sudden increase in afterload following ductal closure may lead to left ventricular dysfunction and heart failure. In older children and adults, CoA typically presents with hypertension in the upper extremities and may eventually be complicated by early coronary artery disease, aortic aneurysm, and cerebrovascular abnormalities. Over time, collateral circulation may develop via intercostal arteries to bypass the narrowing.

The long-term consequences of untreated CoA include aortic aneurysm formation, increased risk of stroke, and lifelong arterial hypertension, underscoring the importance of early diagnosis and timely surgical correction. Current surgical and interventional approaches aim at complete relief of the obstruction. These include balloon angioplasty, endovascular stenting, and surgical repair. The choice of intervention depends on the patient’s anatomy, the degree of narrowing, and age.

Aim - to summarize current data, and analyze follow-up protocols for children with repaired CoA to enable timely identification of complications, diagnosis of recoarctation, and referral for reintervention.

Patients with repaired CoA require lifelong follow-up and regular echocardiographic monitoring due to potential cardiovascular risks and the possibility of reintervention. Cardiac surgery centers offer different strategies for long-term surveillance in children after CoA repair. This paper presents a unified follow-up protocol proposed by the American College of Cardiology (ACC) in 2023 for children after surgical repair of CoA - both within the first year of life and up to 18 years of age. Each algorithm provides recommendations on visit frequency and the types of necessary examinations.

The authors declare no conflict of interest.

Overcoming folate deficiency - a way to prevent neural tube defects (literature review)

E.I. Burbela — 2025-06-15

Ensuring a normal pregravid level of folic acid (FA) is a key to both the reproductive health of women and the health of the unborn child. The impact of folate deficiency on the development of neural tube defects is associated with impaired nucleotide biosynthesis and cell division, increased homocysteine levels, changes in cell methylation potential and gene expression.

Aim - generalizing and clarifying the impact of the effectiveness of fortification of FC products in preventing childhood diseases and identifying priority areas for future interventions.

Randomised controlled trials and observational studies have shown that adequate daily FA supplementation before and during early pregnancy significantly reduces the risk of neural tube defects by up to 30%. This risk can be increased to 80% by fortifying the foods with FAs that women will take before pregnancy, as the main cause of folate deficiency is insufficient dietary intake.

Voluntary fortification does not reduce the incidence of neural tube defects, in contrast to the effectiveness of mandatory fortification. No risks of adverse effects have been identified from existing mandatory fortification programmes that have been implemented in many countries. Current FА fortification programmes contribute to the maintenance of public health in populations.

The authors declare no conflict of interest.

Approaches to providing first aid to children with massive bleeding from the extremities: regulatory framework and world experience

O.O. Starets — 2025-06-15

Massive hemorrhage is one of the leading causes of trauma-related mortality in children, particularly in the context of armed conflict and emergency situations. Despite the availability of numerous international guidelines on bleeding control, the safety and efficacy of tourniquet use in pediatric populations remain controversial.

This systematic review aimed to analyze the current regulatory framework, international clinical recommendations, and scientific evidence regarding the use of tourniquets in children of various age groups in prehospital settings.

The review was conducted in three stages: analysis of Ukrainian Ministry of Health regulations and international protocols; a targeted literature search in the PubMed database using predefined inclusion criteria; and synthesis of findings based on child age, tactical conditions, availability of medical supplies, and responder training level. Eight relevant studies were included, evaluating different commercial tourniquet models (e.g., CAT, SWAT-T, MAT, CRMT) on simulation models and in clinical scenarios.

Findings indicate that tourniquet effectiveness is highly dependent on the child’s age, limb circumference, and device type. In infants, direct pressure and wound packing remain the primary methods of hemorrhage control, while in older children, commercial tourniquets may be used effectively if anatomically appropriate. Ethical constraints limit large-scale studies on uninjured children, yet military experience—particularly from Iraq, Afghanistan, and Ukraine — supports the integration of tourniquets into pediatric trauma care protocols.

Conclusions. This review highlights the need to adapt national guidelines to account for pediatric anatomical and physiological differences, as well as tactical realities. Further research is essential to refine prehospital hemorrhage control strategies and improve outcomes for children with life-threatening bleeding.

The authors declare no conflict of interest.

Analysis of the current state of the problems of diagnosis and minimally invasive treatment of patients with superficial vascular formations of the skin (review of literature)

K.V. Polkovnikova — 2025-06-15

Superficial vascular formation of the skin include a wide range of diseases, which makes their diagnosis and classification difficult. Benign vascular tumors are often mistaken for vascular malformations, but even more often vascular malformations are mistaken for vascular tumors. Such discrepancies in views on the etiopathogenesis of superficial vascular lesions of the skin and delayed diagnosis due to their incorrect classification are responsible for incorrectly selected treatment tactics and, accordingly, for unsatisfactory treatment outcomes and its possible complications.

The aim - to highlight contemporary views on the featuresdiagnostics and minimally invasive treatment of patients with superficial vascular lesions of the skin.

The diagnosis of superficial vascular formations of the skin is based on an assessment of the patient's general condition, the characteristics of the course and clinical picture of the pathological focus (detailing the shape, including relative to the skin level, color, surface and linear dimensions), accompanying symptoms and its anatomical localization. The need for diagnostic examination of superficial vascular formations of the skin increases with the degree of their possible malignancy, in order to monitor the pathology and assess the degree of disease, prevalence and infiltration into surrounding tissues, as well as potential metastasis. Malignant neoplasms of the skin remain an important public health problem today, as they continue to occupy leading positions among the causes of disability and mortality, both in children and adults in many countries of the world.

Conclusions. A wide range of unresolved problems indicates the need for further search for new minimally invasive methods of diagnosis and treatment of superficial vascular lesions of the skin, which should directly depend on the previous diagnosis and differential diagnosis, as well as take into account the indications and all possible contraindications. In addition, the analysis of current trends in the development of medical science indicates the need for further development and search for an ever-increasing arsenal of modern minimally invasive approaches to the diagnosis and treatment of superficial vascular lesions of the skin, which are integrated as an important part of interdisciplinary therapy regimens, especially among the pediatric population, which in turn requires all relevant specialists to have special knowledge, skills and abilities in the management of such patients.

The authors declare no conflict of interest.